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General NPI Number Information
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NPI Number | 1225736150
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Entity Type | Individual
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Provider Name | KISHA DANIEL LMT
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Gender | Female
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Dates
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Enumeration Date | 02/20/2023
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 4413 ROOSEVELT RD STE 100
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City | HILLSIDE
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State | IL
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Zip | 60162-2057
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Country | US
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Telephone | 773-425-1201
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Fax |
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Provider Business Mailing Address
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Address Line | 3449 W MONROE ST
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City | CHICAGO
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State | IL
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Zip | 60624-2957
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Country | US
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Telephone | 312-709-0400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 227.017709
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License Number State | IL
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